Wake-Up Right-Sided Hemiparesis and Dysarthria in a Heavy Snorer

      Case Presentation

      A 57-year-old man was referred to the ED for wake-up right-sided hemiparesis, hypoesthesia, dysarthria, and a National Institutes of Health Stroke Scale score of 7. Urgent CT brain scanning showed an ischemic lesion of the left temporal and insular lobes. The patient was admitted to the stroke unit, and acetylsalicylic acid 300 mg and low-molecular-weight heparin 6,000 IU were administered.
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        • Russell D.C.
        • Jarmukli N.F.
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        • Angeli S.
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        • et al.
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